045001959-10-19-2021-25-AS-RLBN-C86TLF-20211026144923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 10/19/2021
Date Signed: 10/19/2021 11:34:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/04/2021 and conducted by Evaluator Donna Gurriere

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210604154518

FACILITY NAME:	WINDCHIME OF CHICO		FACILITY NUMBER:	045001959
ADMINISTRATOR:	DAVID, RACHEL		FACILITY TYPE:	740
ADDRESS:	855 BRUCE RD		TELEPHONE:	(530) 566-1800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	120	CENSUS: 50	DATE:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	RACHEL DAVID		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is retaining residents with open wounds.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact with Rachel David, Administrator. It was alleged that the Facility is retaining a residents with open wounds.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

continued

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20210604154518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: WINDCHIME OF CHICO	FACILITY NUMBER: 045001959
	VISIT DATE: 10/19/2021

NARRATIVE

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Facility is retaining residents with open wounds.

During the interview process, the administrator and ten staff persons were interviewed. Resident 2 was not interviewed, as the resident is deaf and could not hear on the telephone. Documents were obtained to include the physician’s report, assisted living service agreement and home health notes. It was reported that Resident 2 has an open wound, which started as a cyst on the buttock. Home Health has been providing services to the resident, in which the resident was diagnosed with Carbuncles (infected hair follicles). It was reported that the resident’s physician is considering surgery. The resident has an ongoing skin condition and the resident is prone to having an open wound.

Resident 3 was not interviewed, as the resident resides in the memory care unit and has a hard time with communication. In addition, documents were obtained to include physician’s report, assisted living service agreement and home health notes. Resident 3 was diagnosed with a cutaneous abscess on the buttock, was prescribed antibiotics and is being treated by Home Health Services. Staff persons reported that the resident continually has itchy skin and scratches the abscess, which sometimes leaves it open.

Regarding both residents, the facility is allowed, to have residents with open wounds in that the regulations state the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: When care is performed by or under the supervision of an appropriately skilled professional. The wounds are not considered a stage 3 or a stage 4 pressure injury; therefore, the residents are allowed to reside in the facility.

This agency has investigated the complaint alleging that the Facility is retaining residents with open wounds. Although the residents may have an open wound, it has been determined that the complaint allegation is Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC9099 (FAS) - (06/04)

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